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December 27, 2011

Article: CMS Will Not Provide Interim Feedback Reports for Determining if Individual Providers will Incur the 1% 2012 ERx Penalty for Medicare Part B Fee Schedule Services
   Despite CMS indicating in their 9/6/11 final E-Prescribe rules that providers would receive an interim feedback report to know in advance if they would receive the 1% ERx penalty adjustment as of 1/1/2012, CMS announced 12/20/11 these reports were not "technically feasible" for them to provide.
   In addition, CMS has NOT processed the ERx exemption requests which providers could apply for using the Communication Support Page up until 11/8/11. CMS indicates the volume of these requests was too great. The ONLY email notices thus far sent to providers as a result of their exemption request filings, were sent to providers from QualityNet on 12/9/11. The email notified providers they would not be penalized as of 1/1/2012; BUT WAS NOT due to the actual exemption request reason the provider filed. The email was sent to providers whose actual data had been reviewed for the period 1/1/11 thru 6/30/11 based on the Name/NPI/TIN listed in the exemption request; and determined they were already exempt from the penalty (no filing of an exemption request was required). The email sent to providers was VERY confusing. Here is what the email said:
   "Thank you for submitting a request for a significant hardship exemption from the 2012 electronic prescribing (eRx) payment adjustment. Our records indicate that you submitted one or more requests for a significant hardship exemption to the 2012 eRx payment adjustment. This formal notification is to inform you that the 2012 eRx payment adjustment, which will result in a 1.0 percent reduction on an eligible professional’s 2012 Medicare Part B physician fee schedule covered professional services, does NOT apply to you based on the identifying information received in your hardship request. Therefore, your request(s) for a significant hardship exemption to the 2012 eRx payment adjustment will be disregarded.
   If you received the above email...GREAT!! If you did not, then you will NOT receive any notification as to your penalty status that kicks in as of 1/1/2012, although CMS says they contunue to work on a method for notifying providers. At this late date, do not hold your breath.
   Instead, your first indication as to receiving the 1% penalty will occur when you start receiving your 2012 Medicare remittances. On 12/21/11, CMS posted an article describing the remittance and remark codes that will indicate the 1% penalty has been applied. To read the Medlearn article, click here.
   If the exemption request you filed on the Communication Support Page is ultimately approved by CMS after 1/1/2012, any claims where the penalty applied would then need to be re-processed thus creating further chaos to your patient account reconciliation. The MedLearn article also describes the remittance and remark codes you will see when the ERx penalty is subsequently adjusted.

 
 
 


 

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     As the administrator for a large cardiology practice in Central Florida, I believe one of my toughest challenges is staying up to date on all of the legislative and regulatory changes happening in healthcare on a daily basis. When I have questions, the first place I turn is Leslie Witkin with Physicians First. In the past, Leslie has helped our practice in many ways including consulting with our team to assist with developing a program to successfully implement PQRI. I am fortunate to have many resources at my fingertips for keeping up to date on important issues but Leslie always seems to be one step ahead of me. I recommend her without reservation!
Dorothea M. Wynne, CMPE, Chief Executive Officer, Orlando Heart Center,Orlando, Florida
     Ms. Leslie Witkin is passionate about what she does. Over the many years that I have worked with Leslie, she has consistently and staunchly advocated for physicians especially when dealing with the complexity and ambiguities inherent in complex Medicare and commercial health plan rules and regulations. She is a dependable resource that physicians need to operate a profitable and efficient medical practice.
Robert W. Westergan, M.D., Board Certified, Fellowship Trained Orthopaedic Surgeon
     Leslie Witkin’s expert level knowledge of enrollment, billing, coding and physician practice operations coupled with her unique ability to relate to our customers in a conversational way has made her one of the highest rated speakers we have. She has been an invaluable resource to helping me and the entire DecisionHealth editorial team better understand the complexities and challenges facing physicians – as well as how to solve them.
Scott Kraft, Director, Content Management, DecisionHealth
     In 1999, my husband left an Orthopaedic group to start a solo practice. With the looming prospect of health care issues and regulations, we sought information from many sources. Medical practices exist in a complex regulatory environment. I was so happy when Leslie Witkin scheduled presentations in Vero Beach. I would try to go to every seminar where she was a presenter and still do. Her online webinars are a must for concise up to date information on coding, compliance, enrollment, and other regulatory and payer issues. I know that when I contact Leslie about an issue, she is already aware and has usually finished documentation and guidelines on the subject to present at her training programs. My husband and I want to thank Leslie for her diligence, tenacity in getting the information we need, and concern for our practice.
Sheila Griffin, CPC, CMPM, CCP-P Practice Manager, Orthopaedic Center of Vero Beach, PA
     We hired Leslie Witkin several years ago to review our E/M utilization as well as our strengths and weaknesses in coding and documentation. Training sessions were held with physicians and were so insightful that we have continued to use Leslie for annual training programs. Leslie's knowledge and background in coding issues and Medicare policies is always accurate. During the year I do not hesitate to contact her with other billing and compliance issues.
Patti Reigle, Administrator, CMM, Digestive Health Physicians, P.L. - Ft. Myers, Florida
     I have retained the services of Leslie Witkin and Physician's First, Inc. for the last seven years for her expert advice and services. Leslie is very knowledgeable in all scopes of practice including but not limited to chart auditing, coding, billing, and reimbursement. Leslie has conducted on site reviews that have lead to increased productivity and receipts in my office over the years. I have also retained Leslie Witkin for Management conferences as a guest speaker for topics such as HIPAA and Medicare billing issues. I highly recommend Leslie Witkin and Physicians First, Inc. to any physician, office, or organization.
April Desimone, Practice Administrator, McLeod Orthopedic Clinic - New Smyrna Beach, Florida
     Seminars provided by Physicians First provide timely updates and practical "real life" information needed by medical practice managers. The seminar documents are well researched and are useful reference tools.
Marsha Donaldson, RN, BSN, MBA - Director Operations, Baptist Primary Care, Jacksonville, Florida
     Ms. Witkin is very professional, productive, and skilled in office management. She provides us with researched information and continues to provide us with the latest information related to Medicare changes. We recently had a complicated issue with one of our major payers and she helped me through the process in a very systematic way to resolve the issue immediately. We are grateful to Physicians First and will continue to work with them in the future. Thank you for a job well done.
Beth Soprenuk, Manager, Christopher T. Soprenuk, MD, PA, Hematology-Oncology - Leesburg, Florida
     Although I have never personally met Leslie Witkin, I would like it known that she has been a significant resource to me in my dealings with Medicare policies. Recently, Leslie offered assistance in response to an email I sent to the Medicare Part B list serv regarding a change in Medicare policy. She was in contact with people at CMS and was willing to keep me informed when the questions were answered by the appropriate source. If Leslie is willing to go the distance for a complete stranger, I can only imagine how diligent she would be for her clients.
Patricia Larabee, CPC, CCP, InterMed, South Portland, Maine
     Leslie Witkin's understanding of a policy error on the part of CMS lead her to pursuing the problem with CMS. Thankfully, she kept us informed about each step of her pursuit so that we were able to use this information to make a decision about how to handle the situation. CMS finally corrected the oversight, in great part to Leslie's determination to reach a positive outcome affecting radiologists across the country.
Teresa Halliday, CCS-P, Coding and Compliance Coordinator, Radiology Associates of New Hartford - Utica, New York